2020-10-30T15:06:51-05:00 2019-12-31 208149084 ANASTASI MOORE & MARTIN PLLC 9 S WASHINGTON ST STE 600 SPOKANE WA 99201 990 2019-01-01 916065367 RETIREE'S WELFARE TRUST RETI 2063294900 2323 EASTLAKE AVE E SEATTLE WA 98102 JOE TESSIER CHAIRMAN 2063294900 2020-10-30 1 PAUL ANASTASI P00395796 5093230272 2020-10-28 65.141.209.234 2020-10-30 14:51:37 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 46CAEAA8ACE1A846D2D686457D1D3826578CD455 2019 2021-04-22 16:20:28Z JOE TESSIER 2323 EASTLAKE AVE E SEATTLE WA 98102 51457750 0 X N/A X 1964 WA TO PROVIDE HEALTH BENEFITS FOR RETIRED EMPLOYEES WHO MEET THE ELIGIBILITY RULES IN EFFECT WHEN THEY RETIRE AND/OR QUALIFIED MEMBERS OF THEIR FAMILY. 6 6 0 6 0 0 0 0 31158607 41110946 1104415 1359326 0 0 32263022 42470272 0 0 27003562 26994923 0 0 0 0 0 3307365 3514288 30310927 30509211 1952095 11961061 66484264 80896989 5114410 4772131 61369854 76124858 TO PROVIDE HEALTH BENEFITS FOR RETIRED EMPLOYEES WHO MEET THE ELIGIBILITY RULES IN EFFECT WHEN THEY RETIRE AND/OR QUALIFIED MEMBERS OF THEIR FAMILY. 0 0 THE TRUST PROVIDES HEALTH BENEFITS FOR RETIRED PARTICIPANTS AND THEIR SPOUSES AND DEPENDENTS. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1465 0 1 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X NORTHWEST ADMINISTRATORS 2067263253 2323 EASTLAKE AVE E SEATTLE WA 981023305 X ANTHOYNY DECOSMO TRUSTEE 1.00 0.00 X 0 0 0 RANDY ZEILER TRUSTEE 1.00 0.00 X 0 0 0 STEVEN C CHANDLER TRUSTEE 1.00 0.00 X 0 0 0 TED BUNSTINE TRUSTEE 1.00 0.00 X 0 0 0 JOE TESSIER CHAIRMAN 1.00 0.00 X X 0 0 0 BRIAN PERSON SECRETARY 1.00 0.00 X X 0 0 0 0 0 0 0 0 0 0 NORTHWEST ADMINISTRATORS INC 2323 EASTLAKE AVENUE E SEATTLE WA 981023393 ADMINISTRATIVE SERVICES 2906537 PREMERA BLUE CROSS 7001 220TH STREET SW MS 103 MOUNTLAKE TERRACE WA 98043 PPO NETWORK 287793 2 EMPLOYER CONTRIBUTIONS 900099 23299929 23299929 RETIREE SELF-PAYMENTS 900099 17811017 17811017 41110946 1346804 1346804 9000000 8987478 12522 12522 12522 42470272 42457750 0 12522 26994923 26994923 2762991 2762991 9973 9973 51563 51563 153124 153124 496415 496415 21180 21180 3572 3572 14478 14478 OTHER ADMINISTRATIVE EX 992 992 30509211 30509211 0 0 4893082 8152765 1161245 2266991 12280 12307 60417657 70464926 66484264 80896989 2614410 2122131 2500000 2650000 5114410 4772131 X 0 0 0 0 61369854 76124858 61369854 76124858 66484264 80896989 11961061 2793943 0 X 0 1 X 0 0 0 CLAIMS INCURRED BUT NOT REPORTED 2650000 2650000 X 45111091 2793943 2793943 42317148 153124 153124 42470272 30197436 0 30197436 153124 158651 311775 30509211 PART X, LINE 2: THE TRUST ESTABLISHED UNDER THE PLAN TO HOLD THE PLAN'S ASSETS IS QUALIFIED PURSUANT TO THE APPROPRIATE SECTION OF THE INTERNAL REVENUE CODE (IRC) AND, ACCORDINGLY, THE TRUST'S NET INVESTMENT INCOME IS EXEMPT FROM INCOME TAXES. THE PLAN HAS OBTAINED A FAVORABLE DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE (IRS), BUT HAS SINCE BEEN AMENDED. HOWEVER, THE PLAN ADMINISTRATOR BELIEVES THAT THE PLAN IS CURRENTLY DESIGNED AND BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC. THEREFORE, THEY BELIEVE THAT THE PLAN IS QUALIFIED, AND THE RELATED TRUST IS TAX-EXEMPT AS OF THE FINANCIAL STATEMENT DATE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN INCLUDED IN THE PLAN'S FINANCIAL STATEMENTS. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2019, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF THE LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS, AND THE PLAN COULD BE SUBJECT TO INCOME TAX IF CERTAIN ISSUES WERE FOUND BY THE IRS THAT COULD RESULT IN THE DISQUALIFICATION OF THE PLAN'S TAX-EXEMPT STATUS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XII, LINE 4B - OTHER ADJUSTMENTS: TOTAL OBLIGATIONS OTHER THAN POSTRETIREMENT BENEFIT OBLIGATIONS CY 2,927,177. TOTAL OBLIGATIONS OTHER THAN POSTRETIREMENT BENEFIT OBLIGATIONS PY -2,768,526. FORM 990, PART VI, SECTION A, LINE 3 THE BOARD OF TRUSTEES HAS SELECTED A PROFESSIONAL THIRD PARTY ADMINISTRATOR TO RUN THE DAY TO DAY OPERATIONS OF THE TRUST. THE BOARD OF TRUSTEES RETAINS ULTIMATE RESPONSIBILITY FOR THE ACTIONS OF THE THIRD PARTY ADMINISTRATOR. FORM 990, PART VI, SECTION B, LINE 11B NO REVIEW WAS OR WILL BE CONDUCTED. FORM 990, PART VI, SECTION B, LINE 12C MANAGEMENT MONITORS POLICY FOR CONFLICTS OF INTEREST BY REVIEWING ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 EXAMINE WITHOUT CHARGE AT THE PLAN ADMINISTRATOR'S OFFICE AND AT UNION HALLS OF ALL PLAN DOCUMENTS INCLUDING INSURANCE CONTRACTS, COLLECTIVE BARGAINING AGREEMENTS, AND COPIES OF ALL DOCUMENTS FILED WITH THE U.S. DEPARTMENT OF LABOR, SUCH AS ANNUAL REPORTS AND PLAN DESCRIPTION. OBTAIN COPIES OF ALL PLAN DOCUMENTS AND OTHER PLAN INFORMATION UPON A WRITTEN REQUEST TO THE PLAN ADMINISTRATOR. THE ADMINISTRATOR MAY MAKE A REASONABLE CHARGE FOR THE COPIES. RECEIVE A SUMMARY OF THE PLAN'S ANNUAL FINANCIAL REPORT. THE PLAN ADMINISTRATOR IS REQUIRED BY LAW TO FURNISH EACH PARTICIPANT WITH A COPY OF THIS SUMMARY FINANCIAL REPORT. GRAYS HARBOR COUNTY 102 W BROADWAY MONTESANO WA 98563 916001320 WA 0 MONROE CITY OF - SERGEANTS & LIEUTENANTS 806 WEST MAIN ST MONROE WA 98272 916001464 WA 0 PORT OF SEATTLE 2711 ALASKAN WAY SEATTLE WA 98121 916001025 WA 0 PORT TOWNSEND CITY OF - GENERAL EMPLOYEES 250 MADISON STREET PORT TOWNSEND WA 98368 916001024 WA 0 WASHINGTON TEAMSTERS WELFARE TRUST 2345 EASTLAKE AVE E SEATTLE WA 98102 916034673 WA 0 ALLIED WASTE 501 MONSTER RD SW RENTON WA 98057 650716904 WA 0 ANHEUSER-BUSCH SALES OF WASHINGTON INC 3215 LIND AVE SW RENTON WA 98057 455087500 WA 0 ARAMARK UNIFORM SERVICES 7810 S 228TH ST KENT WA 98032 953082883 WA 0 BIMBO BAKERIES USA 25838 104TH AVE SE KENT WA 98030 752491201 WA 0 CADMAN INC 18816 NE 80TH ST REDMOND WA 98052 910162302 WA 0 CLEANSCAPES INC 7303 8TH AVE S SEATTLE WA 98108 911852894 WA 0 COCA COLA REFRESHMENTS USA INC 1110 112TH AVE NE STE 300 BELLEVEUE WA 98004 580503352 WA 0 DARIGOLD INC 4058 RAINIER AVE S SEATTLE WA 98118 910730043 WA 0 DEL MONTE CORPORATION 49 E 3RD AVE TOPPENISH WA 98948 463991361 WA 0 DHL EXPRESS 4450 E MARGINAL WAY S SEATTLE WA 98134 943380425 WA 0 FOOD SERVICES OF AMERICA 1001 SHUKSAN WAY EVERETT WA 98203 410826179 WA 0 GARY MERLINO CONSTRUCTION 9125 10TH AVE S SEATTLE WA 98108 911296882 WA 0 GLACIER NORTHWEST INC 5975 E MARGINAL WAY S SEATTLE WA 98134 911518360 WA 0 GOLDEN STATE FOODS 1409 PUYALLUP ST SUMNER WA 98390 952670074 WA 0 HOGLAND TRANSFER CO 6605 HARDESON RD EVERETT WA 98203 910712520 WA 0 HOS BROTHERS CONSTRUCTION 7733 W BOSTIAN RD WOODINVILLE WA 98072 910791022 WA 0 HUTTIG BUILDING PRODUCTS INC 525 C ST NW AUBURN WA 98001 431908841 WA 0 ICON MATERIALS 4040 KERSEY WAY SE EVERETT WA 98092 911272258 WA 0 LAKESIDE INDUSTRIES 6505 226TH PL SE 200 ISSAQUAH WA 98027 910751657 WA 0 MILNE FRUIT PRODUCTS INC 804 BENNETT AVE PROSSER WA 99350 910938042 WA 0 NW CONSTRUCTION INC 2353 130TH AVE NE 100 BELLEVEUE WA 98005 911487252 WA 0 OCEAN SPRAY CRANBERRIES 1480 WA-105 ABERDEEN WA 98520 041215610 WA 0 OMA CONSTRUCTION INC 22412 SE 231ST ST MAPLE VALLEY WA 98038 911912492 WA 0 PEIRONE PRODUCE COMPANY 9818 W HALLETT RD SPOKANE WA 99224 WA PENINSULA TRUCK LINES INC 1001 N HAVANA ST SPOKANE WA 99202 910583906 WA 0 PIERCE COUNTY REFUSE CO 4111 192ND ST E TACOMA WA 98446 WA SAFEWAY INC 5918 STONERIDGE MALL RD PLEASANTON CA 94588 943019135 CA 0 SHASTA BEVERAGE 1227 ANDOVER PARK E TUKWILA WA 98188 942977421 WA 0 SUPERVALU HR SHARED SERVICES 1525 E D ST TACOMA WA 98421 430781167 WA 0 SYSCO FOOD SERVICES OF SEATTLE INC 22820 54TH AVE S KENT WA 98032 760254395 WA 0 SYSCO FOOD SVCS OF SPOKANE 300 N BAUGH WAY POST FALLS ID 83854 331082518 ID 0 THE BOEING COMPANY 7701 14TH AVE S SEATTLE WA 98108 910425694 WA 0 UNITED PARCEL SERVICE 4455 7TH AVE S SEATTLE WA 98108 362407381 WA 0 UNITED STATES BAKERY 340 NE 11TH AVE PORTLAND OR 97232 930302130 OR 0 URM GROCERY CO 7511 N FREYA ST SPOKANE WA 99217 910447070 WA 0 US FOODS 9399 WEST HIGGINS ROAD SUITE 100 ROSEMONT IL 60018 363642294 IL 0 USFREDDAWAY 7720 SW MOHAWK ST BLDG H TUALATIN OR 97062 930262830 OR 0 WASTE MANAGEMENT INC 1021 MAIN ST HOUSTON TX 77002 363846342 TX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 TRANSACTIONS WITH RELATED TAX-EXEMPT ORGANIZATIONS S 595621 CASH TRANSACTIONS WITH RELATED CORPORATIONS S 18734192 CASH